上海市15年妊娠合并心脏病的临床资料分析

Retrospective Epidemiological Study of Pregnancy Complicated by Heart Disease during 15 Years in Shanghai

目的：探讨妊娠合并心脏病的变化趋势。方法：对上海市１０所教学医院１９８１～１９９５年住院分娩的妊娠合并心脏病患者的临床资料进行回顾性分析。结果：３７９０６５例分娩中，合并心脏病２６８０例，发病率为０．７１％；死亡１５例，病死率为０．５６％，死亡专率为３．９６／１０万，占孕产妇总死亡数的１２．４０％。将１５年分为１９８１～１９８５年、１９８６～１９９０年、１９９１～１９９５年３个时期观察，心脏病孕妇的死亡率分别占总死亡数的４．４８％、２２．８６％及２１．０５％。先天性心脏病孕妇１３３３例，占４９．７４％；风湿性心脏病孕妇７５９例，占２８．３２％，前者与后者之比为１．７６１，从３个时期的资料来看，二者的比例分别为１．２７１，２．３７１及２．８１１。心功能Ⅰ级与Ⅱ级者共占妊娠合并心脏病患者总数的８５．４５％，发生心力衰竭者为７．６０％。妊娠合并心脏病的围产儿死亡率为７．７６‰。分娩方式常采用剖宫产。结论：妊娠合并心脏病至今仍是孕产妇死亡的主要原因之一。应建立孕前咨询中心，根据其心脏病种类及分型、心功能状况进行评分，以判定该患者能否妊娠。

Objective: To investigate the changes of pregnancy complicated by heart disease. Method: Clinical data of hospitalized pregnant women with heart disease, collected from 10 teaching hospitals in Shanghai during 1981～1995, were analysed retrospectively. Results: 2 680 of 379 065 deliveries (0.71%) were complicated by heart disease during that period. There were a total of 121 maternal deaths, 15 of them due to heart disease, the mortality of heart disease was 0.56%, and the percentage in total maternal deaths was 12.40%. The incidence and mortality rates were similar in 1981～1985, 1986～1990, 1991～1995, but the percentage due to heart disease increased after the late 1980s. The rates of congenital heart disease increased and rhumatic heart disease decreased apparently, the ratio of the former to the latter was 1.76∶1. The pregnancy induced hypertension heart disease, the peripartum cardiomyopathy and the miscellaneous heart disease all increased obviously during the 1990s. The heart functions of grade I and Ⅱ accounted for a considerable proportion (85.45%), but the grade Ⅳ tended to increase during the 1990s. Heart failure occurred in 172 cases, with an incidence of 7.6%. The perinatal mortality rate was 7.76‰. Cesarean sections were often performed in heart disease women. Conclusion: Pregnancy complicated by heart disease is still one of the major causes of maternal deaths up till now. More effective management should be adopted.